Changes in our retiree health coverage options - we have been under United Heathcare - the only choice we had. Former employer is dumping them and offering a choice between Kaiser and Blue Cross.

DH and I are in the process of gathering info to make the pick. Our situation: no kids, no major health problems, just a couple of routine prescriptions for meds. We're in a major metro area (DC) with no plans to leave soon. Advice??

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Changes in our retiree health coverage options - we have been under United Heathcare - the only choice we had. Former employer is dumping them and offering a choice between Kaiser and Blue Cross.

DH and I are in the process of gathering info to make the pick. Our situation: no kids, no major health problems, just a couple of routine prescriptions for meds. We're in a major metro area (DC) with no plans to leave soon. Advice??

Thanks

Is this a choice between a PPO type plan and an HMO? At least out here, Kaiser is an HMO. That is a big categorical choice. Beyond that, find out what you can about the qulity of care in the two organizations in your area.

Ha

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"As a general rule, the more dangerous or inappropriate a conversation, the more interesting it is."-Scott Adams

If the Blue Cross plan is a PPO and reasonably priced compared to Kaiser, I would take it no question. With Kaiser, you have to use their facilities or you will have no coverage if it's an HMO or pay out of network rates if it's a POS plan.

__________________Disclaimer - I am an independent insurance agent. If the above message contains insurance-related content, it is NOT intended as advice, and may not be accurate, applicable or sufficient depending on specific circumstances. Don't rely on it for any purpose. I do encourage you to consult an independent agent for insurance-related advice if you have a question that is specific in nature.

I, and other state employees in Hawaii, have a choice between a Blue Cross-Blue Shield PPO and a Kaiser HMO. I chose the PPO, HMSA, and have been happy with that, but many seem to like the Kaiser plan. I asked a friend in the Kaiser plan for his comments on it, and he said Kaiser has some first rate specialists, but it can be a problem to get referred to them so you can be treated by them.

I, and other state employees in Hawaii, have a choice between a Blue Cross-Blue Shield PPO and a Kaiser HMO. I chose the PPO, HMSA, and have been happy with that, but many seem to like the Kaiser plan. I asked a friend in the Kaiser plan for his comments on it, and he said Kaiser has some first rate specialists, but it can be a problem to get referred to them so you can be treated by them.

You also have no coverage if you're out of the service area with Kaiser HMO. From what I understand, you can't even use other Kaiser networks around the country, only the ones in your area.

__________________Disclaimer - I am an independent insurance agent. If the above message contains insurance-related content, it is NOT intended as advice, and may not be accurate, applicable or sufficient depending on specific circumstances. Don't rely on it for any purpose. I do encourage you to consult an independent agent for insurance-related advice if you have a question that is specific in nature.

You also have no coverage if you're out of the service area with Kaiser HMO. From what I understand, you can't even use other Kaiser networks around the country, only the ones in your area.

I thought they had provisions for out-or-area urgent care and emergencies. Maybe someone who has the Kaiser plan can check their benefits and let us know; it may even be a regulatory requirement.

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Rich
San Francisco AreaESR'd March 2010. FIRE'd January 2011.

As if you didn't know..If the above message contains medical content, it's NOT intended as advice, and may not be accurate, applicable or sufficient. Don't rely on it for any purpose. Consult your own doctor for all medical advice.

Two negatives about Kaiser HMO (Georgia in my case) from the top of my head:
- when out of their coverage area they only cover ER visits.
- wait time for a specialist can be long.
Nevertheless for routine medical coverage convenience is hard to beat:
One stop shopping for most things (PCPs, some specialists, lab, CT-Scan/MRI/Xray/pharmacy), online health records and no paperwork to worry about.

Please recheck on the statements about out of network care for Kaiser. In the DC area, the clinics are Kaiser specific, however, the hospital care is outsourced locally. With Kaiser you use their pharmacies and clinicians, unless that service is outsourced. I worked for Kaiser in California for 14 years and provided clinical engineering support to the Mid-Atlantic area. As for healthcare outside of the DC area, I believe, as like I have now for TRICARE, you must call for out of network care and possibly pay a premium - for emergency care, you will be covered, however, they will try to re-patriate you to the Kaiser system once you are stabilized.

Depending on what your issues are, Kaiser has some of the best outcomes as measured against some of their competitors. You can ask for a different primary care doctor and they (the primary care provider) are a gateway to other services, however, I found their care to be as good or better than any I've had anywhere (military, US private and internationally (German and Polish)). As with any type of service, it pays to be an educated consumer - with the internet, one can at least do some rudimentary research before consulting your clinician.

Kaiser also has one of the most advanced EHR systems and patient access to electronic services via the EHR is currently award-winning - it is fairly standard across the different regions.

So, I guess I'm a cheerleader, but I can understand why some people may not like the way the services are organized. If I were in your place, I would look at what you expect to use in the healthcare system and then compare and contrast the costs, coverage and access ease to make your decision.

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Deserat aka Bridget
“We sleep soundly in our beds because rough men stand ready in the night to visit violence on those who would do us harm.” - George Orwell/Winston Churchill

Sailor, that is not true. If Kaiser is not reasonably available you are covered for out of area care. I had Kaiser until I moved out of their service area. I went to college out of their area and received services, I vacationed was covered for services. You will be covered for services that could not reasonably wait until you returned home.

Kaiser in Portland metro uses many specialists who are not their own, trauma patients go to the trauma hospital, patients needing cardiac surgery go to a hospital noted for that specialty. It is true that you cannot just see a specialist and expect them to pay for it if you don't have a referral but I am not aware that appropriate care is not provided. It is my understanding that statistically the Kaiser system provides better health outcomes than self-managed health care.

Frankly I loved their urgent care clinics, you can receive attention in the evening and weekends

In the last year I moved back to their service area and am on Medicare. They are more expensive than GEHA now so signed up with them, but after a scramble to find a physician accepting patients where medicare is primary I almost wish I had paid the extra for Kaiser.

For those who wonder about the quality of their health care professionals, they have no lack of top notch applicants. Their staff don't have to worry about office administration, work hours, and they have peers to help solve difficult diagnostic problems.. they aren't perfect, medicine is a human endeavor, but very very good.

Sailor, that is not true. If Kaiser is not reasonably available you are covered for out of area care. I had Kaiser until I moved out of their service area. I went to college out of their area and received services, I vacationed was covered for services. You will be covered for services that could not reasonably wait until you returned home.

Hmm, I wonder if it's plan dependent, because that's not what our Kaiser rep told us and not been experience with road warriors at our mega corp.
Kaiser would not cover their Urgent Care physician bills when outside of coverage area, so if they had Kaiser, they either needed to pay out of pocket or go to the ER for example for an ear infection.
Most of our traveling dudes are on Cigna plans solely for this reason, although few of them have Kaiser because it's better for the rest of the family staying at home.
Also my plan at Kaiser would not cover any health care abroad, excepting ER visits.
Fortunately in most places abroad we can afford to pay out of pocket, as most of the time we only see pediatricians (we travel with our three small kids).

And I do like and recommend Kaiser for people with fixed home address, for reasons stated in my first post

It is surprising how many Kaiser patients I have met over the years who are quite content with their care. There was considerable political resistance to staff model HMOs at first, but others followed. Kaiser itself used to have a reputation for stinginess regarding outside referrals and in-house expensive testing but many of the opponents were stakeholders in the opposition.

The only persistent complaint I have heard is crowded clinics and brief visits but it has been a while and I don't know if that continues. When I think of the new "Accountable Health Plans" it makes me wonder if some of them might have some similarities to Kaiser.

__________________
Rich
San Francisco AreaESR'd March 2010. FIRE'd January 2011.

As if you didn't know..If the above message contains medical content, it's NOT intended as advice, and may not be accurate, applicable or sufficient. Don't rely on it for any purpose. Consult your own doctor for all medical advice.

People either think Kaiser is the best thing since sliced bread or they hate it with a passion. There seems to be no in-between. Regarding the out of network coverage, I would tread carefully on the assumption that Kaiser will pay for any OON care if it's an HMO plan. Most plans only count OON services as in-network if it is a life or death emergency. I will stand by the statement that I would take a PPO Blue Cross/Blue Shield plan over an HMO Kaiser plan any day if the benefits and rates are comparable.

__________________Disclaimer - I am an independent insurance agent. If the above message contains insurance-related content, it is NOT intended as advice, and may not be accurate, applicable or sufficient depending on specific circumstances. Don't rely on it for any purpose. I do encourage you to consult an independent agent for insurance-related advice if you have a question that is specific in nature.

One of the problems in answering this is that Kaiser works very differently in different parts of the country. In CA where they started and are a major provider, you are locked into their network and facilities for almost everything. In other areas, they don't have that same infrastructure, contract for more services and look more like a network model HMO.

Some people do get good results at Kaiser, but for the best results you need to learn how to work the system. My wife, for example, was covered by Kaiser for several years and never actually saw an MD, only Nurse Practioners (not to start a discussion of NPs vs. MDs, but she wasn't happy with the care she got). That was when she could get an appointment, which was never easy. To put this in context, she was working for Kaiser in a management position during this period.

Conventional wisdom among the people I know from Kaiser is that if you have a serious health problem you will probably get excellent care. But access to care for routine problems can be frustrating. You definitely have more control over your care elsewhere.

You also have no coverage if you're out of the service area with Kaiser HMO. From what I understand, you can't even use other Kaiser networks around the country, only the ones in your area.

In general, the Kaiser Permanente plans cover out-of-area emergency treatment to stabilize a problem. Routine treatment from another Kaiser network requires permission from your 'home' network, and is not that hard to get. It IS more work than just showing up at a KP clinic and showing your card, though.

Thanks for all the replies! DH and I just read through all your posts and we both want to thank you for your thoughtful input. Please keep 'em coming - we have until the end the the month to make a choice and will continue doing research and thinking this through.

One comfort is we'll be able to make a change in a year during open season if we don't like the company we choose.

I think a key difference is that philosophically Kaiser is a health care organization. The focus is on preventing illness when possible and bringing together an appropriate treatment team when the member is ill. This is different than an insurance program that pays medical bills.

They do want a member to choose a primary care provider who gets to know you but some people just 'grab and go' whomever is available. My Kaiser OB has passed away (Dr. Roger George) but his relationship with his patients was hard to replicate. One of his patients had a high risk multiple pregnancy when that was a rarity. His wife went to the patent's home to help with the babies for years, after she died and he became frail that family had him move in with them so he could receive comparable care.

My son was exceptionally adventuresome. One of their physicians lived nearby and would take him to work for followups. Once a staff member asked me who was his primary care physician and I gave her the name of the gal he saw most frequently. The response was, "Chief of Trauma?" My response was, now you know the kind of kid I have. To this day we still go to dinner with her and her husband.

Here in Puget Sound the closest thing to Kaiser is Group Health Coop. In fact, GHC members who live here but winter in CA can use Kaiser just as if they were home.

I think it has plusses and minuses. I have an older friend who has dealt with many health problems, and he has a woman friend who is GHC member and loves it. But my friend says that she is very good at working the system. If she is having trouble getting the referral she wants, she shows up at one of their contract hospitals, where the mandate appears to be different.

Group Health members can get free gym memberships at a number of nice and convenient gyms. Also some dental coverage, and a monthly price quite a bit lower than the only other high rated possibilities.

Ha

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"As a general rule, the more dangerous or inappropriate a conversation, the more interesting it is."-Scott Adams

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